Tag Archives: Kerri Wachter

Oncology is about to take a huge step toward changing the way that cancer is understood and treated with the development of a breast cancer-specific prototype for a rapid learning system in cancer care. This system takes advantage of health IT advances (such as EHRs) in order to connect oncology practices, measure quality and performance, and provide physicians with decision support in real time.

The prototype is part of the American Society of Clinical Oncology’s (ASCO’s) vision for CancerLinQ a “system that assembles and analyzes millions of unconnected medical records in a central knowledge base, which will grow ‘smarter’ over time,” according to the organization.

Illustration courtesy of the American Society of Clinical Oncology

As part of ASCO’s focus on quality improvement, the protoype will use clinical practice guidelines and measures of the Quality Oncology Practice Initiative to build quality measurement and clinical decision tools. Next, breast cancer patient records and data (stripped of identifying information) imported from the electronic health records (EHRs) of academic centers and oncology practices will be added.

As a proof of concept, ASCO says that the prototype will:

provide the foundational information and lessons learned to allow ASCO to move into a full-scale implementation;

demonstrate a set of value-added tools; including a physician’s ability to measure their performance against a sub-set of QOPI measures in real-time;

demonstrate the ability to capture data from a variety of sources and aggregate the data using novel methodologies;

and create a demonstration which will allow exploration of data in unprecedented ways and generate hypotheses related to breast cancer.

Once the full technology platform is completed, CancerLinQ ultimately is expected to improve personalized treatment decisions by capturing patient information in real time at the point of care; provide decision support to cancer teams to adapt treatment plans to each patient and his or her cancer; and report on quality of care, compared with clinical guidelines and the outcomes of other patients. It’s also hoped that the system will help to “educate and empower patients by linking them to their cancer care teams and providing personalized treatment information at their fingertips.” Lastly, the system stands to be a powerful new data source for analysis of real-world quality and comparative effectiveness, as well as to generate new ideas for clinical research. It’s hoped that in time, this approach can be adapted to all types of cancer.

London may not be considered by everyone as exotic a locale as Beijing, but travel safety shouldn’t be overlooked across the pond. The CDC has several travel factsheets and resources for physicians and patients heading to the London Olympic Games, which start July 27 and run through Aug. 12.

Start by checking out Healthy Travel to the 2012 Olympic Games — the CDC’s rundown on basic health information for the UK, including a handy translation guide for UK health-related terms. If you’ve ever been curious about national healthcare, a mishap in London could answer a lot of questions. Of course, so could an informational website developed by the UK’s National Health Service. The CDC also offers a link to travel tips from the U.S. State Department.

Wondering about the top travel advice for Americans headed to the games? Update your routine vaccines, including measles. “In 2011, some U.S. residents who traveled abroad got measles. When they returned to the U.S. they caused 17 measles outbreaks in various communities.” Probably the most important tip for a Yank in London: look both ways. “Look right, look left, and look right again to avoid stepping into the path of traffic. In England, people drive on the left side of the road, not the right. Your safety is important. Road traffic is one of the leading causes of injury death to U.S. travelers in foreign countries.”

Homicide continues to be the second leading cause of death for youth aged15-24, and the leading cause of death for African American youth, according the CDC. More than 700,000 young people aged 10 to 24 were treated in emergency departments in 2010 for injuries sustained due to violence.

While identifying risk factors for teen violence is a necessary component of combating the problem, the experts recognize that it’s also important to identify factors that protect youth against youth embracing violence — such as resilience, positive youth development and community assets. “Most youth, even those living in high risk situations, are not violent and more must be learned about the factors that are helping youth, protecting them from engaging in violent behavior so that others can benefit,” the experts wrote in the supplement.

The CDC convened the Expert Panel on Protective Factors for Youth Violence Perpetration to clarify unresolved definitional and analytic issues on protective factors; review the state of evidence regarding the factors that appropriately can be labeled as direct protective, buffering protective, or both; carry out new analyses of major longitudinal surveys of youth to discover new knowledge about protective factors; an assessing the implications of research identifying protective factors for prevention programs, policies, and future research. This supplement presents the group’s work on direct protective factors — in particular identifying factors that exhibit mostly direct protective effects.

For more information about youth violence in the United States, check out a number of resources available on the CDC’s violence prevention Web page.

What does Title IX mean to you? Athletics is typically high up on the list for many people. Title IX has played an important role in getting girls and young women onto the field. On the 40th anniversary of the landmark gender equity in education legislation, U.S. Secretary of Education Arne Duncan noted in a speech, “when Title IX was enacted in 1972, less than 30,000 female students participated in sports and recreational programs at NCAA member institutions nationwide. Today, that number has increased nearly six-fold. And at the high school level, the number of girls participating in athletics has increased ten-fold since 1972, to three million girls today.”

In an era of nationwide public health concerns over childhood obesity, getting girls and young women involved in sports becomes even more important. However, Title IX’s expansion of school-based athletics programs has more far-reaching benefits as well. As Secretary Duncan pointed out, female athletes “are more likely to graduate from college than female students who don’t play sports.” Female athletes are also less likely to use drugs and become pregnant as teenagers.

Sports are only part of the Title IX picture though. In fact, neither the word “sports” nor “athletics” are used in the text of the legislation. The law has changed the academic landscape for female students.

U.S. Navy photo by Greg Vojtko (Public Domain)

Here’s a few things that you might not know:

57% of students in postsecondary education in 2009-2010 were women; women also accounted for 62.6% of students receiving a master’s degree.

Since 1976, girls enrolled in gifted and talented education programs have outnumbered boys enrolled. In 2009, 8.1% of girls participated in gifted and talented education programs, compared to 7.4% of boys.

A greater percentage of the girls in 7th or 8th grade (20%) are taking Algebra I, compared with boys (18%).

Girls are evenly represented in biology and outnumber boys in chemistry, but are underrepresented in physics.

Welcome to middle age, Title IX. Let’s see what else you can do to get girls on the field and in the classroom.

Here are the top five contact allergens that are missed using the standing 28-allergen screening tray (T.R.U.E. Test), according to Dr. Donald V. Belsito, who presented the top 25 at the annual meeting of the American Contact Dermatitist Society in San Diego. The results are based on a retrospective analysis including 2,088 patients who were patch tested from 1995-2010.

The CLEOPATRA, BOLERO-2, and AVEREL trial results generated a lot of excitement (and confusion) in San Antonio at the annual Breast Cancer Symposium. Since the results were finally released, these trials have been hot topics. There’s good reason.

In the CLEOPATRA trial, the addition of pertuzumab to trastuzumab and docetaxel in previously untreated patients with HER2-positive metastatic breast cancer extended progression-free survival (PFS) by 6 months compared with trastuzumab and docetaxel alone. In BOLERO-2, the combination of everolimus and exemestane extended PFS by 4 months (local review) and by 7 months (central review) in women with ER-positive, HER2-negative breast cancer that is refractory to non-steroidal aromatase inhibitors. In AVEREL, the addition of bevacizumab to trastuzumab and docetaxel in women with HER2-positive, locally recurrent metastatic breast cancer also improved PFS — by 2.8 months (local assessment) and by 2.9 months (central assessment).

This is all great news but biomarkers to identify the patients who actually benefit the most from these new regimens would be even better news. All three presenters at one press conference — Dr. Luca Gianni, Dr. Gabriel Hortobaygi, and Dr. Jose Baselga — stressed the need for these tools. All three of these trials involved exploratory components to assess potential biomarkers to predict response.

“The common theme … of our three studies is that we have a challenge with the development of new drugs in identifying biomarkers that will determine which is the group that can be enriched and will derive the lion’s share of the benefit of adding drug X,” said Dr. Hortobaygi. “None of our new drugs in this panel has such a biomarker as yet. There is much work being done in all three studies to try to identify biomarkers that will help us to do that,” he said.

“That continues to be one of the major challenges for bevacizumab. We did not have a biomarker that can tell us that we can treat less than 100% of patients to observe the benefit. I think that most of us on this panel believe that most of these drugs provide benefit to a subset of patients and not to everybody. That is an ongoing challenge and we really need to invest in and redouble our efforts, so that we can develop those biomarkers,” he added.

Dr. Gianni told me that a biomarker for bevacizumab seriously could help with drug development. “If there was a biomarker, this combination could become very, very promising and would deserve analysis, head to head with other very active treatments in the case of HER2-positive disease.”

Image courtesy of NIH (public domain)

Dr. Howard A. Burris III told me that it makes sense based on what we already know that not every patient will benefit from the same treatments. “We know that not all ER-positive women are the same. The BOLERO-2 trial looked at adding the mTor inhibitor everolimus to exemestane in patients with ER-positive breast cancer. [However], you’ve got patients that have 10% ER overexpression and some that have 100%. Then you’ve got groups of patients who relapsed after the adjuvant therapy, so they didn’t have a long-lived response, and some that have had d great response in the metastatic setting. Those patients are not at all alike,” he said.

“I think we’re going to find that there isn’t this one size fits all and I think that the closer we get to this idea of having a panel — where you’re going to find out what the various overexpressions are for these patients — the clearer we’re going to be about who should get what.” Dr. Burris is the chief medical officer and the director of drug development at the Sarah Cannon Research Institute in Nashville.

“The primary toxicity, interestingly, for many of the new biologics is the financial toxicity. So it’s perfectly acceptable to give a relatively expensive therapy to the 10% of that it’s going to benefit greatly. The shame is that you can’t treat 10 patients to help that one patient who will benefit most. Somewhere in between is a societal decision,” Dr. Burris said.

“I think we’ve got to get closer to the idea that when a woman gets her original biopsy or surgery that you learn everything you can about that patient; then, at the time of relapse — if that’s unfortunate enough to occur –- if possible get a biopsy to see what’s changed; but if not, at least your first attempt in treating that relapse is going to be in the right direction. Identifying who’s the group at highest risk for relapse or who needs to stay on therapy longer are all going to be factors that are going to be important going forward,” said Dr. Burris.

Dr. Gianni noted that it’s easy to envision that these regimens potentially could be used earlier in the disease progression for women with breast cancer, who are identified by a biomarker to respond well to one of these regimens. It makes sense that these regimens could be used earlier for women identified by a biomarker to respond well to one of these regimen, he said.

Rheumatology has a been a tad slower than other specialties to adopt more advanced imaging modalities, preferring to stick with ultrasound and venturing into MRI. Based on this year’s still image winner in the “Image of the Year” contest at this year’s American College of Rheumatology meeting though, the specialty appears to be embracing innovative new ways of imaging rheumatic diseases.

Image courtesy of the American College of Rheumatology and Dr. Chaudhari

This year’s winner is a combined PET-CT image of the finger joints in patients with psoriatic arthritis. The image was submitted Abhijit Chaudhari, Ph.D. of the UC Davis School of Medicine in Sacramento.

According to Dr. Chaudhari’s poster from the meeting, his group has built an extremity scanner that is capable of sequentially performing 3D positron emission tomography (PET) and fusing the image with a 3D anatomical CT image. In the poster, they reported their initial experience in using this system for assessing metabolic activity in RA, PsA and OA of the hand. Regions of enhancement on PET (F18-FDG) are markers of increased metabolic activity and, in turn, inflammation.

While the technique is still in early trials, the researchers hope that one day they will be able to not only identify the disease but also monitor early response to anti-TNF-alpha therapy in RA and characterize bone remodeling (osteoblastic) activity in early OA.

The best overall submission and category winning submissions from this year’s contest will be published in a future issue of Arthritis & Rheumatism and will be featured in the online Rheumatology Image Bank.

You can read more about this year’s ACR meeting and watch video interviews with key presenters at Rheumatology News.com.